Armstrong J G
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, N.Y. 10021.
Cancer Treat Rev. 1990 Mar;17(1):1-13. doi: 10.1016/0305-7372(90)90073-o.
Long-term survival (greater than or equal to 3 years) is possible in a small proportion of patients with SCLC, particularly if the disease is limited in extent. The influence of thoracic irradiation on the long-term outcome of limited stage patients is controversial, although there is a suggestion of benefit. Despite the use of irradiation, thoracic recurrence is the single most important site of treatment failure. Further experience will be necessary to determine if radiotherapeutic strategies to enhance thoracic control can improve long-term survival. Prophylactic cranial irradiation (PCI) may influence long-term survival of limited stage patients who achieve a complete response to therapy and remain controlled in the chest. However, this is not clearly established and must be considered in the light of the contribution of PCI to neurotoxicity occurring in survivors. Reduction in the radiation fraction size and the omission of chemotherapeutic agents which cause neurotoxicity, either alone or by synergism with PCI, are reasonable approaches to pursue in an attempt to prevent this complication. A small proportion of NSCLC occurring after treatment of SCLC may be preventable by attempts to eradicate NSCLC components present in the original SCLC. Leukemogenic chemotherapy agents may contribute to the development of secondary ANL, and should probably not be used in view of the availability of alternative equally effective agents.
一小部分小细胞肺癌（SCLC）患者有可能实现长期生存（大于或等于3年），尤其是疾病范围局限的患者。胸部放疗对局限期患者长期预后的影响存在争议，尽管有证据表明其有益。尽管使用了放疗，但胸部复发仍是治疗失败的最重要单一部位。需要更多经验来确定增强胸部控制的放射治疗策略是否能提高长期生存率。预防性颅脑照射（PCI）可能会影响对治疗完全缓解且胸部病情得到控制的局限期患者的长期生存。然而，这一点尚未明确确立，必须考虑PCI对幸存者发生神经毒性的影响。减少放疗分次剂量以及避免使用单独或与PCI协同导致神经毒性的化疗药物，是预防这种并发症的合理方法。通过试图根除原始SCLC中存在的非小细胞肺癌（NSCLC）成分，有可能预防一小部分SCLC治疗后发生的NSCLC。致白血病化疗药物可能会导致继发性急性非淋巴细胞白血病（ANL）的发生，鉴于有同样有效的替代药物，可能不应使用。
